Archive for the ‘Health Care Reform’ Category

The United States has, for a long time, been the subject of criticism for not offering paid maternity or family leave to the average worker.

Most of America’s advanced, democratic counterparts in Western Europe and North America offer paid maternity/family leave as a part of their national healthcare system. Yet, in the United States, only 13 percent of the workforce has access to such a benefit, according to the Department of Labor.

Recently, though, there has been a push to nationalize a paid-leave policy for such reasons. President Obama, who has always been in favor of a nationalized maternity-leave compensation program, has repeatedly expressed his support for setting aside $2.2 billion in 2016’s budget to help a number of states set up paid-leave systems, according to Kaiser Health News.

Moreover, the Democratic party has proposed a revised Family and Medical Insurance Leave Act (originally passed twenty years ago) that would create national paid-leave programs that cover up to two-thirds of a worker’s wages for up to 60 days.

The current legislation makes any type of maternity or family-related leave difficult in the United States. As it stands, mothers and those who need to take care of invalid family members are granted unpaid leave under national law, however its legal purview does not extend to companies with fewer than fifty workers or to many employees who have not notched 1,250 hours of labor at their current jobs, according to Kaiser.

Three states that do have paid maternity leave (California, New Jersey, and Rhode Island) are home to some of the leading advocates for a national paid maternity leave policy. According to the Legal Aid Society Employment Law Center, California state law grants six weeks of leave per year at 55% of their weekly pay.

California is somewhat of a pioneer in the fight for paid-leave in the United States. However, many small business across the country oppose the implementation of policies akin to the one in the Golden State. And, with the Republican Party in control over Congress, it does not seem as though any significant changes will be made to national government’s paid-leave policies in the next couple of years. However, staffing agencies and small business owners should certainly pay attention to this issue.

The new healthcare act enables patients with pre-existing conditions to obtain affordable coverage.Additionally, these patients can’t be penalized with higher rates than healthier participants. In terms of out-of-pocket expenses, the maximum set for individuals is $6,350, and $12,700 for families.Once these amounts are reached, insurers will then pick up the full tab.

Nevertheless, patients taking costly prescription drugs are more likely to reach these levels fast.While certain medications for serious conditions can cost thousands of dollars a month, some plans under the new exchanges may place as much as 50 percent of the cost on patients.Basically, plans with lower monthly premiums require patients to bear higher portions of drug costs.

In addition to premiums, many other factors impact drug costs for patients.Among these factors is a drug’s tier, or level of coverage.Tiers vary from plan to plan, and can be classified into different categories: generic, brand, preferred and specialty drugs.In order to determine tiers, insurers and drug manufacturers negotiate prices for each particular drug. Drug costs are greatly impacted by these tiers, which can make all the difference in patient costs.

As a result, high price tags and costly co-pays are associated with high-tiered drugs.According to insurance-industry experts, many businesses are anticipating larger numbers of sicker, costlier patients to sign up for the exchanges.This trend could lead to financial troubles if an inadequate number of healthier customers sign-up and balance out those costs.Regardless, insurers are not allowed to impose higher charges on chronically ill patients.Therefore, in order to keep monthly premiums lower, patients are forced to pay more for high-tier drugs.

Although the numbers are impressive, the Obama administration said it is still far from reaching its original goal.Marilyn Tavenner, the administrator for the Centers for Medicare & Medicaid Services, previously reported that the administration had set their hopes for reaching 800,000 total enrollees throughout the months of October and November.

In October, more than 100,000 people enrolled for healthcare coverage under Obamacare.The majority of the enrollees came from state-run exchanges, while only about 27,000 signed up for coverage through the federal website, HealthCare.gov.

The Affordable Care Act is highly dependent upon younger, healthier enrollees who can help keep coverage costs down by offsetting costs for older, sicker individuals.Nevertheless, a poll released by the Harvard Institute of Politics revealed that only 29 percent of uninsured Americans between the ages of 18 and 29 said they would definitely or likely sign-up for coverage through the healthcare exchanges.

Some physicians have even voiced their concerns to various medical associations.These doctors explained that the discounted rates could cause a two-tiered system to develop, where fewer doctors would be willing to participate.As a result, consumers could have a harder time obtaining necessary care.

Nevertheless, insurers have been under plenty of pressure to make premiums more affordable for consumers.As a result, insurance officials have reduced the rates for some plans. Additionally, because plans usually are comprised of smaller networks, insurers believe that doctors will be compensated for pay decreases as more patients come to them for care.However, when it comes to providing care for current patients, many primary care physicians admit that they are already pressed for time.

A major reason for this conflict is that doctors aren’t always sure which plans they are listed under, or even how much payment they should expect to receive from patients covered under a certain plan.Additionally, some physicians are just starting to find out about the decreasing pay rates among particular plans sold through Obamacare’s online exchanges.

According to a senior executive at Blue Cross Blue Shield Association, a few of its 37 member organizations are already providing lower rates to doctors that belong to smaller exchange plan networks.However, the executive also said that an adequate amount of doctors are being enlisted within their plans, and that insurers are well aware that a good network of providers is necessary to retain patients.

Regardless, some doctors have a different opinion.Contracts established between insurers and physicians can vary, and some even permit insurers alone to alter rates of payment issued to doctors.Furthermore, insurers may enlist doctors into several different plans.As a result, several physicians are undecided as to whether or not they will participate in the new plans.

In a survey conducted by The Medical Society of the State of New York, more than 400 doctors were asked if they would participate in an insurer’s exchange plan.Among the respondents, 40 percent said that they would not participate, and one-third said they were unsure.Lastly, two-thirds admitted that they never received any type of reimbursement information.

Therefore, individuals who were in favor of their current coverage plans may be able to keep them for another year. However, once midterm elections are complete, plans that are not in accordance with the new healthcare law will get canceled again.

The new transitional policy introduced by the administration will enable people who were happy with their insurance to remain on their current plans, as long as their policies were effective on Oct. 1 of this year. Furthermore, another stipulation for this newly-enacted policy is that insurers provide free advertisements for their competitors on Obamacare’s online exchanges.

Aside from the 25 million Americans who opt for their own coverage through the individual market, several employees covered by employer-based insurance will also encounter cancellations. Currently, 156 million people obtain healthcare through their employers.

In addition to this particular provision, there are many other aspects of Obamacare that will not be enforced yet, such as postponing the employer mandate for a year. These and other unilateral actions are being announced by the White House, since the administration wants to avoid the potential for Congress to pass legislative amendments to the new healthcare law.

In order for this cancellation fix to actually work, insurers must find some way to rush their old products into the marketplace by January 2014. This will be extremely difficult for insurers to pull off.Since new reimbursement rates for 2014 would have to be negotiated with doctors and hospitals, insurers would have to submit these plans to state insurance regulators in order to obtain approval.

Even with the change, the administration is leaving it up to each individual state to determine whether or not residents can keep coverage plans that are not in accordance with the new healthcare initiative.As a result, state insurance commissioners, along with other health policy experts, have established the fact that insurance plans will greatly vary across the country.

In order to be productive and perform at their best, nurses must remain healthy and alert.However, nurses who work prolonged shifts often report that they feel fatigued, which ultimately results in patient dissatisfaction. Even though there are no policies in place regulating nurse shifts in the U.S., hospital scheduling software can help healthcare administrators avoid the negative effects of prolonged shifts on nurse health.

A recent study published by the British Medical Journal’s Occupational and Environmental Medicine revealed that nurses who work prolonged shifts are at a greater risk for developing breast cancer than their colleagues who take on shorter shifts.Additionally, according to Scrubs magazine, the correlation between prolonged hospital shifts and breast cancer is caused by disruptions to internal body mechanisms, which are responsible for maintaining a person’s health.

Aside from cancer risk, nurses who endure prolonged hospital shifts are also at risk for other types of diseases.According to Scrubs, many reports have found that healthcare employees who work night shifts or longer hours are at a higher risk for developing diabetes and prostate cancer.Other potential health issues reported included sleep deprivation, burnout and emotional fatigue.

Lastly, in a study conducted by MedScape, research revealed that longer shift lengths were directly linked to both patient and nurse dissatisfaction. Nurses who worked 10 or more hours were at a greater risk of being burned out and unhappy with their profession.Furthermore, nurses’ well-being was also correlated with patient experiences.The study showed that longer hospital shifts resulted in undesirable outcomes for both patients and nurses.

Although the new health reforms enacted by the White House have resulted in more affordable health coverage for many Americans, this trend has only impacted the overall price of insurance. However, when it comes to the caps placed on premiums through Obamacare, several insurers will offer a lot less cash for services provided by top-grade doctors and hospitals. While thousands of policies with varying levels of coverage exist, many policies cover a much smaller network of doctors and hospitals.

Recently, Watchdog.org contacted the top 18 hospitals across the country, as determined by U.S. News and World Report for 2013-2014. The investigation was conducted to learn more about the hospitals’ established contracts. Additionally, several insurance companies were also contacted. Based on the findings, Watchdog.org concluded that several top hospitals are opting out of Obamacare.

Nevertheless, many individual health plans purchased outside of Obamacare were likely to enable patients to receive care from these top-tier facilities. For instance, Cleveland Clinic accepts numerous health plans purchased within the individual marketplace. However, once an individual opts to buy coverage through Obamacare, the only way they can receive care from the Cleveland Clinic is by electing insurance through Medical Mutual of Ohio.

In spite of this limitation, there are plenty of coverage options available through the state exchanges. In Ohio and California, there are a plethora of insurance companies within the online marketplace. However, two of the top-grade hospitals in these states (Cleveland Clinic and Cedars-Sinai Medical Center) only accept coverage from one company in their network.

Several state exchanges don’t provide a list of their insurers on their websites. For California and other states that do offer this information to consumers, names of doctors or hospitals are unavailable. Although it’s yet to see how well they will play out, health care reform law provisions have been established requiring an adequate number of providers in each insurance network. It’s likely that more providers will opt in once the marketplaces have been around a bit longer.

With the introduction of new healthcare reforms enacted by the Affordable Care Act, many Americans covered by health insurance in the individual marketplace will be forced to enroll in new coverage plans. People will be required to opt for new insurance since many of these plans are not in accordance with newly established standards set by the new healthcare law. As a result, many insurers will be forced to either tack on benefits, or cancel policies altogether.

As more and more people have been receiving policy cancellation notices paired with new offerings provided by their insurer for 2014, the sticker shock has brought on increased feelings of aggravation among those impacted. Many are unhappy with the options offered in the marketplace. Some face climbing premiums and costly increases in deductibles. Some report their current deductibles of $1,500 are expected to rise to $5,000 under Obamacare for similar policies. It isn’t just deductibles, visits to the doctor and prescriptions are also subject to increase.

Nevertheless, a small number of existing plans will become grandfathered. In order to obtain this status, two qualifying factors must be met. First, members must have been enrolled in these policies before the passage of the ACA back in March 2010. Additionally, no significant policy changes should have been made to the plans until now, ranging from alterations in co-pays and deductibles to coverage costs.

Currently, Blue Cross Blue Shield is one of the major healthcare providers within the individual insurance marketplace, as well as the exchanges. Kim Holland, the trade group’s executive director of state affairs, said that the majority of existing individual plans offered by Blue Cross will soon be altered or discontinued. As a result, some customers will be forced to enroll in new coverage plans.

Although customers may receive letters indicating significant increases in premiums, they won’t exactly know what to expect in regards to payments until they actually explore the exchange. Generally, if an individual brings in less than $46,000 a year or $94,200 for a family of four, federal subsidies will be available to decrease monthly expenses.

Although the new healthcare exchanges under Obamacare will be accessible to everyone, the marketplace will operate through two different sites, depending upon where you live. In 34 states, the exchanges will be available on HealthCare.gov, a federally-run website. However, 16 states, including the District of Columbia, will operate their own independent exchanges. Regardless, even if your employer already provides health coverage, there are no rules saying you can’t purchase coverage on your state’s exchange.

If employees decide to abandon their employers’ plan and enroll in coverage through the new marketplace, they may not be eligible to receive some of the benefits provided to the uninsured. The only instance where employees could be deemed eligible for receiving government subsidies is when their employer’s coverage is determined unaffordable or inadequate under the new healthcare law. Because these subsidies help people pay for their insurance, they are one of the most attractive incentives available with the new state exchanges.Keep in mind, employees earning over $40,ooo annually, won’t likely qualify for subsidies.

Opinions differ when it comes to choosing the best coverage plan for employees. According to E. Denise Smith, a professor of health care management at Gardner-Webb University in Boiling Springs, N.C., there really would be no advantages to abandoning healthcare plans provided by employers. She also mentioned that employers would not be required to offer payment assistance if their employees opted for an exchange plan.

A senior vice president for health policy at Jackson Hewitt, expressed a similar point of view. He believes that employees may not be able to find better coverage than their work-based plan among the new marketplaces. Additionally, he advises employees to thoroughly evaluate their current employer-based plans, and consider factors such as whether or not dental and vision care are covered. Obamacare plans are not required to cover dental and vision.

In regards to employee eligibility for Obamacare, many of the requirements imposed on employers had been postponed until 2015. However, companies were still expected to offer notice to their employees no later than Oct. 1, letting workers know whether or not their current coverage would be viewed as affordable under the new law. Despite this expectation, the U.S. labor Department said that employers would not be charged with penalties for failure to notify their employees. Regardless, the delayed employer mandates will require businesses with a workforce of at least 50 full-time employees to provide health coverage to their workers, as well as their dependent children, in 2015. However, employers will not be obligated to offer insurance to workers’ spouses.

The Cleveland Clinic has previously attributed their budget decision to “a number of factors”, as have other hospital systems considering or implementing similar cuts. Now, hospitals spokespersons and health care analysts have provided a more in-depth explanation of exactly how the Affordable Care Act will affect hospital systems going forward.

Medicare

Hospitals already handle a large annual gap between the health care they provide to Medicare recipients and the reimbursement limits that the Centers for Medicare and Medicaid Services place on various services. The ACA includes an additional Medicare spending reduction of $716 billion over the next ten years. Some of the cuts are specifically directed at hospitals, such as the Hospital Readmissions Reduction Program.

Another portion of the pending cuts to hospitals is $22 billion over ten years from the Disproportionate Share Payments (DSH), which cover charity care in hospitals with large numbers of uninsured patients. Hospitals expect to compensate for this particular cut with insurance payments from previously uninsured patients who will have access to coverage through the federal health exchange. These cuts come in addition to other reductions approved by Congress since the ACA passed in 2010.

Medicaid

The ACA expanded Medicaid coverage to include patients earning up to 138 percent of the federal poverty level, in an attempt to provide an affordable health care option to parts of the population too poor to pay a monthly premium even with tax subsidies to help. To ease state concerns about the costs of expansion, the federal government will pay all new Medicaid costs through 2016, when they will scale back their coverage to 90 percent.

However, when the Supreme Court upheld the ACA’s individual mandate they failed to uphold the obligation of the states to expand their individual Medicaid programs. In states such as Ohio and North Carolina where the government has chosen not to expand, hospitals will not be able to recoup the loss of Medicaid DSH funds cut through the ACA. With fewer newly eligible Medicaid patients than projected, hospitals are forced to contain their costs through other means.

Bad debt

Hospitals must already contend with bad debt from patients who do not cover the portion of their invoices beyond coverage limits, as well as costs they swallow from providing charity care. The Medicare and Medicaid restrictions described above will contribute to this ongoing problem but interestingly enough, so will the health plans available to patients in the online marketplaces.

The affordability of health care is a complex matter that goes beyond the cost of the monthly premium. Insurers balance low premiums such as those available in Bronze or Silver plans with higher deductibles and out-of-pocket costs, meaning that a patient who seeks care at the hospital will end up with a higher portion of the bill once that care is provided. As much as a third of uncollectible hospital bills are estimated to belong to patients with health care.

Still, hospitals are optimistic that higher numbers of insured patients will create a net gain, as they will be able to reduce their bad debt expenses for uninsured patients and will instead receive payment for at least part of services provided directly from the insurer.

The Cleveland Clinic is one large example of how the Affordable Care Act may affect hospital operations, yet they also offer an important caveat against framing the discussion of other facilities’ budget decisions solely within the context of the ACA.

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